Paidamoyo Chipunza Health Reporter
PEOPLE on medical aid will fork out cash co-payments and incur shortfalls as medical aid societies refuse to recognise Government’s recent tariff hike. The Association of Healthcare Funders of Zimbabwe (AHFoZ) said the Statutory Instrument effecting the tariff increase did not compel them to honour the new healthcare charges.
Information gathered by The Herald shows that health insurers are reimbursing general practitioners the old tariff of US$20 a visit and US$80 for specialist services.
The gazetted tariff for general practitioners is US$35 a visit, while specialists should charge US$120.
AHFoZ said following consultation with lawyers, medical aid societies understood that the new Statutory Instrument did not bind them to pay the newly-gazetted fees.
Section 16A(c)(ii) of the Medical Services (Medical Aid Societies) Regulations, 2000 quoted in the relevant Government Gazette, entails doctors and hospitals to abide by the gazetted tariffs, but is silent on medical aid societies.
They cite the sections which read: “No health-care provider shall do any of the following: ‘Demand from any person referred to in paragraph (a) any payment by way of a consultation fee or deposit or other similar payment how-so-ever described in excess of the amount specified by the Minister by notice in the Gazette, in the absence of an agreement referred to in subparagraph (i)’.”
AHFoZ said it would continue reimbursing at the old rate.
“The legal opinions available confirm that the general notice refers to the maximum fees that service providers may charge,” said AHFoz. “It does not require health funders to pay the fees as set out in the general notice.
“Consequently, health funders under AHFoZ will maintain the status quo on tariffs. Efforts to engage service providers will continue in order to find a lasting solution.”
The development has incensed the Zimbabwe Medial Association which yesterday called for an urgent meeting of the Joint Advisory Council to deal with the impasse.
“AHFoZ has shown its total disregard for the law by writing to its members to ignore the law on the new tariffs,” said Zima. “The JAC should urgently reconvene to address and review issues of service provision by all funders of health care in Zimbabwe and enforce existing legislation to ensure that service providers are not prejudiced and patients are protected.”
The practitioners said they would respect and adhere to the gazetted tarrifs.
They also condemned medical aid societies for sending patients outside Zimbabwe for procedures available locally.
The impasse between medical aid societies and health insurers dates back to before the introduction of a multi-currency regime in 2009 when the parties failed to agree on a common tariff.
A common tariff means the charge by a service provider will be reimbursed at the same rate by the health insurer.